Why CARE's programs educate the community on how to report

This letter was published in the Jakarta Post - It's the frustrations of an expat living in Bali who tried to report a dead bird in his back yard.

Often, there' s big disconnect between the national system for surveillance and communities. The story also highlights the need for avian flu response to be multisectoral - this man called the hospital, police, media and his village chief! None of them knew how to report a dead bird!

"On Aug. 26 I found a dead wild bird in my yard. I am living in Bali near the area where bird flu related deaths have occurred. Since I was worried about the possible risk connected with dead birds, I tried to contact some authority to guide me on how to handle this situation.

I tried to reach the main hospital in Bali, Sanglah, and the answer was to go there if sick but they do not know anything regarding dead birds or chickens.

Next I tried to contact 110, the emergency number of the police: there was no answer. I tried then with the health and animal departments: again no answer.

I then called a newspaper office and spoke with a journalist there: she did not know of any special procedure in place to handle the bird flu-related problems neither she was aware of any emergency number.

I tried then to contact the head of my village (in the Kerobokan area) and his reaction was: "Just bury the bird, there is no problem." How would he know?

Eventually I obtained, through a friend, the personal cell phone number of a doctor nice enough to put me in touch with two nice guys from the animal department who came to my house to check the bird four hours after I began my search for information. Well this does not seem anywhere near a coordinated response to the bird flu problem."

http://www.thejakartapost.com/detaileditorial.asp?fileid=20070829.F07&irec=6

An H5N1 outbreak in poultry in Germany, contaminated straw believed to be the source

160,000 birds were culled in Northern Bavaria after H5N1 was confirmed in domestic poultry. Though there is limited details, it's believed that contaminated straw could be the source.

http://www.iht.com/articles/ap/2007/08/27/europe/EU-GEN-Germany-Bird-Flu.php

Though Western European countries often detect H5N1 in wild birds found dead, it's rare to see it in domestic poultry.

Two more provinces in Vietnam affected by H5N1

Poultry outbreaks in Vietnam and human cases in Indonesia have been fairly regular events in 2007, with reports every few weeks at least. More from the latest poultry outbreak in Vietnam...

From Reuters:

"The outbreak of H5N1 in the northern province of Thai Nguyen and Dong Thap to the south brought to four the number of provinces on the government's current bird flu watchlist.
Vietnam has 64 provinces.
A total of 150 ducks and 35 chickens fell sick on Wednesday in Thai Nguyen, 80 km (50 miles) north of Hanoi, and tests have confirmed they had the H5N1 virus, the ministry's Animal Health Department said in a report.
The virus also struck a farm in the southern Mekong delta province of Dong Thap where 250 chickens were found dead on Sunday, it said."


http://www.alertnet.org/thenews/newsdesk/HAN236817.htm

Is South Asia becoming the new AI hot spot?

We're seeing more and more poultry outbreaks in Bangladesh, India & Pakistan, though no human cases have yet to be detected. Though Southeast Asia still gets most of the attention, more frequent outbreaks in South Asia deserve our attention.

This week in Pakistan authorities killed over 35,000 birds after 14,000 died from H5N1.


"ISLAMABAD, Aug 21 (Reuters) - Pakistani authorities have detected an outbreak of the H5N1 strain of bird flu at a poultry farm in a northwestern town and have culled more than 35,000 birds, a government official said on Tuesday.
Several outbreaks of H5N1 strain of avian influenza have been found in birds this year in Pakistan, where the virus first appeared in early 2006. Pakistan has had no human cases.
The new outbreak was found in late July at a big farm in Mansehra town, 80 km (50 miles) north of the capital, Islamabad.
"Samples were tested after reports of the death of about 14,000 chickens," said Food and Agriculture Ministry official, Rafiq-ul-Hassan Usmani.
"The remaining 35,000 birds were culled after the samples tested positive," he said. "

http://www.alertnet.org/thenews/newsdesk/ISL76664.htm

WHO updates the clinical management guidelines for treating AI in humans

For more info, go to:

http://www.who.int/csr/disease/avian_influenza/guidelines/clinicalmanage07/en/index.html

Indonesia - New poultry and human cases across the islands

The second human fatality from H5N1 in bali has been confirmed. The 28 year old woman was a poultry trader.

http://www.alertnet.org/thenews/newsdesk/JAK170091.htm

Meanwhile, we're actually starting to get more and more reports of poultry outbreaks in Indonesia, which used to be a rarity. Hopefully this indicates that surveillance is improving along with general awareness.

"Despite health authorities` efforts to contain a two-week-old bird flu outbreak in Palu, Central Sulawesi`s provincial capital, the virus proves to have spread to neighboring Donggala district, a local official said. The provincial administration had conducted a number of measures to prevent the virus from spreading to other areas, Greesje Kuhu, head of veterinarian health affairs at South Sulawesi`s agricultural, plantation and animal husbandry office, said here on Monday.A total of 208 chickens were found dead in Palu recently. Rapid tests were conducted to find out the cause of the sudden deaths and the results of the tests showed that 29 chickens had died of bird flu (Avian Influenza) virus or H5N1."


http://www.antara.co.id/en/arc/2007/8/20/bird-flu-in-palu-spreads-to-donggala-central-sulawesi/

West Africa struggles to contain H5N1

From Voice of America, a firsthand look at the difficulties of providing compensation...

"Alex Thiermann, a director at the Paris-based World Organization for Animal Health, says people who raise animals in sub-Saharan Africa tend to be among the poorest, which makes it hard to convince them to kill their livelihood.

"It is very difficult to explain to them that we need to destroy birds because we worry about a potential pandemic," he said. "They do not have time to worry about the potential. They have so many problems to fight on a daily basis so unless there is a good incentive program where there is an assurance they will not lose anything by reporting, then it is hard to guarantee full participation."

Fowl vendors wait for buyers in a fowl market in Lagos, Nigeria, 06 February 2007Donors have promoted paying farmers as one way to encourage fast reporting. But there have been problems paying farmers for their lost poultry because it is not easy to prove ownership.
Olga Jonas, the World Bank's economic advisor for influenza programs who coordinates bird flu donor giving, says local officials need to identify poultry farmers and inventory their stock to prevent corruption.

"When there is an outbreak, you do not get into a lot of discussion about whether somebody did or did not have the poultry they are now claiming compensation for," she said.
But she admits it is hard to track small producers who live in remote areas. Noncommercial family-owned poultry farming is common in West Africa, where people often live in close contact with their birds"


http://www.voanews.com/english/2007-08-18-voa16.cfm

Maid with little opporunity for contact with birds is Indonesia's latest fatality

"The Health Ministry's laboratory has confirmed a Tangerang domestic helper died from the bird flu virus Friday, bringing the country's death toll to 83.
The victim died at Tangerang's Sari Asih Hospital on Tuesday after two days of treatment for a high fever and acute pneumonia, a release made available for The Jakarta Post confirmed Saturday.

The maid's employers, Wahyu Proyato and Winda Amalia, who are residents of Perumnas II in Tangerang regency, said they had no idea how their maid contracted the virus because there were no fowl at their home or in the neighborhood"




http://www.thejakartapost.com/detailcity.asp?fileid=20070820.C04&irec=3

Good news in the search for vaccine solutions

The latest study on the GSK vaccine efforts showed surprisingly good progress when using an adjuvant, an additive that makes it possible to use less vaccine. Also, the vaccine was able to produce an immune response to multiple strains of the virus.

"In fact, the dose needed for a good response was almost four times lower than that used normally in influenza vaccines, meaning limited supplies would stretch to more people.
The researchers also found the vaccine produced immune responses against H5N1 subtypes from Vietnam and Indonesia.

Potentially, the vaccine, made by GSK, could be produced in advance before it was known what strain was causing a pandemic, they said. "

http://news.bbc.co.uk/1/hi/health/6949465.stm

New poultry outbreak in Vietnam

From Viet Nam News

"Ha Noi — Northern Cao Bang Province bordering China re-entered the black list of provinces infected by bird flu this year as test results on a batch of dead birds in the province proved H5N1 positive, according to the Animal Health Department.

Eighty nine chickens and ducks died last Saturday at the farm of Nong Cong Hoan in Ban Loc Village, Kim Dong Commune of Thach An District near the border with China’s Guangxi Province.

Test results by the Ha Noi-based Animal Health and Diagnosis Centre on Monday found H5N1 virus in the dead poultry, the Ministry of Agriculture and Rural Development’s Animal Health Department confirmed yesterday.
During the peak period when avian flu struck the country in early June this year, 18 cities and provinces were infected with the outbreak, including Cao Bang."

http://vietnamnews.vnagency.com.vn/showarticle.php?num=05SOC160807

Teenager dies in Indonesia

From the Jakarta Post

"JAKARTA (JP): Health Ministry said Thursday bird flu had killed one more victim, raising Indonesia’s death toll to 83 out of 103 infected people.
The ministry spokesperson, Lily Setyowati, said a 17-year-old girl, resident of Tangerang, Banten province, was positively died of the H5N1 virus.
“Two laboratories confirmed that the dead girl has tested positive for bird flu,” she told The Jakarta Post."

http://www.thejakartapost.com/detailgeneral.asp?fileid=20070816164323&irec=3

Meanwhile, tests have concluded that a 2 year old neighbor of the Bali woman that died last week does not have H5N1

http://www.komnasfbpi.go.id/news_august_15_07.html

New H5N1 poultry outbreaks in Togo

From yahoo news: http://news.yahoo.com/s/afp/20070811/wl_africa_afp/healthflutogo;_ylt=A0WTcVDP571GFJwA4ANvaA8F

"LOME (AFP) - Three new cases of the deadly H5N1 strain of bird flu have been detected in poultry on farms in the west African nation of Togo, a report said Saturday.

The new cases were found in dead birds on farms in the Lacs, Golfe and Zio regions east of the capital Lome, national television reported.

In late June, testing confirmed the presence for the first time in Togo of the H5N1 strain in poultry in Sigbehoue, 45 kilometres (30 miles) east of the capital.

About 8,000 poultry birds were slaughtered in the area and local poultry markets were closed. Togolese authorities also stepped up controls on poultry imports."

Indonesia’s 103th Bird Flu Case Confirmed in Bali

A story that's making a lot of headlines, the first human H5N1 case in Bali.

From the official Komnas website in Indonesia: http://www.komnasfbpi.go.id/news_august_13_07_1.html

"Jakarta, August 13, 2007 - Ministry of Health - A female bead-embroidery worker, “NLP” (F, 29 years old) from Tukad Aya Hamlet, Negara sub district, Jembrana District, Bali Province was confirmed as Indonesia’s most recent human H5N1 case. The tests conducted by the Research and Development Center of the Ministry of Health and the Eijkman Insitute in Jakarta on August 12, 2007 and August 13, 2007, respectively, confirmed that “NLP” is infected by the H5N1 virus. “NLP” is the 82th fatalities in the country and is the first human bird flu case confirmed in Bali. There are 12 provinces that have recorded human bird flu cases with the total number of 103 confirmed human H5N1 and 82 fatalities. With this case, the human H5N1 case fatality rates now stands at 79.6%, which means from 5 people infected by bird flu, only 1 person survives."

Conflicting reports are popping up about the victim's daughter. Some reports say she has also tested postive, others say she's negative. We'll wait until we get a very reliable source to post.

Joint report highlights need for community level preparedness

Among some of the highlights of the workshop report from the "Technical Meeting on HPAI and Human H5N1 Infection" which took place in Rome on 27-29 June, organized by FAO, OIE, WHO in collaboration with UNSIC and UNICEF, were these comments on taking preparedness from the national to the community level.

"Progress in the public health dimensions of this work has been substantial as evidenced by the
pandemic preparedness actions that have been developed and/or implemented by different
countries. However, most progress has been in establishing plans for actions at countries national levels: the work should be expanded to prepare communities and provinces especially within those countries which have significantly decentralised governance structures. There is a particular need for capacity to communicate relevant information to the public, systematically, at these subnational levels – before and during an influenza pandemic."

The full report can be accessed at:

http://www.fao.org/avianflu/en/conferences/june2007/documents.html

Indonesia defends itself

In response to the recent criticism over virus sharing, Triono Soendoro, head of the Indonesian health ministry's research and development centre, had these comments:

"We sent the samples in May good faith. It was a donation, a courtesy, in the hope that there would be a fair mechanism in the near future," he said of the samples sent in May "But so far no such mechanism exists. It is still being discussed. If we do it again now, we are worried that we will be deceived again," he told Reuters."

http://in.reuters.com/article/worldNews/idINIndia-28865520070807?pageNumber=2

New study says nonpharmaceutical interventions are important during a pandemic

The Journal of the American Medical Association recently published a study demonstrating that, during the 1918 pandemic, cities that implemented multiple public health measures (quarantine, closing schools, banning public gatherings and other social distancing measures) over longer times fared better than those that did not.

From the abstract:

"Context A critical question in pandemic influenza planning is the role nonpharmaceutical interventions might play in delaying the temporal effects of a pandemic, reducing the overall and peak attack rate, and reducing the number of cumulative deaths. Such measures could potentially provide valuable time for pandemic-strain vaccine and antiviral medication production and distribution. Optimally, appropriate implementation of nonpharmaceutical interventions would decrease the burden on health care services and critical infrastructure.

Results There were 115 340 excess pneumonia and influenza deaths (EDR, 500/100 000 population) in the 43 cities during the 24 weeks analyzed. Every city adopted at least 1 of the 3 major categories of nonpharmaceutical interventions. School closure and public gathering bans activated concurrently represented the most common combination implemented in 34 cities (79%); this combination had a median duration of 4 weeks (range, 1-10 weeks) and was significantly associated with reductions in weekly EDR. The cities that implemented nonpharmaceutical interventions earlier had greater delays in reaching peak mortality (Spearman r = –0.74, P < .001), lower peak mortality rates (Spearman r = 0.31, P = .02), and lower total mortality (Spearman r = 0.37, P = .008). There was a statistically significant association between increased duration of nonpharmaceutical interventions and a reduced total mortality burden (Spearman r = –0.39, P = .005).

Conclusions These findings demonstrate a strong association between early, sustained, and layered application of nonpharmaceutical interventions and mitigating the consequences of the 1918-1919 influenza pandemic in the United States. In planning for future severe influenza pandemics, nonpharmaceutical interventions should be considered for inclusion as companion measures to developing effective vaccines and medications for prophylaxis and treatment. "

You can read the abstract at: http://jama.ama-assn.org/cgi/content/abstract/298/6/644

Time magazine also did an article: http://www.time.com/time/health/article/0,8599,1650634,00.html

Suspected H5N1 cases in Vietnam dies

The 15 year old boy with suspected H5N1 infection passed away enroute to Hanoi for treament, according to Than Nien Daily News.

"15-year-old Cao Trong Toan died en route to Hanoi from the northern province for emergency treatment.

On the 19th of last month, the patient’s family bought 20 geese to raise at home.

Three days later all the geese had died and Toan developed a high fever."


http://www.thanhniennews.com/healthy/?catid=8&newsid=30773

Will we ever resolve the virus sharing debate?

Reuters is reporting that Indonesia is still not sharing live viruses, but instead sent "fragments" from the latest victim in May that contained no live virus and where, therefore, unusable for vaccine production.

The impasse between Indonesia and WHO continues despite a meeting in Singapore last week to work out how viruses should be shared.

Is there any end in sight? The World Health Assembly (all 193 member states) will officially address the issue in the May 2008 assembly meeting... hope that isn't too late!

http://in.reuters.com/article/worldNews/idINIndia-28852120070806?pageNumber=2

New human case in Vietnam?

Than Nien Daily is reporting a possible human H5N1 case reported by the national anti-bird flu commitee.

"Dr Nguyen Hai Yen of the National Institute for Clinical Research of Tropical Diseases said the student’s samples were being tested for the H5N1 virus strain, which has killed 45 people in Vietnam since 2003, three of them in the past two months.

The student was transferred to the institute from a hospital in Thanh Hoa province where he had been treated for 12 days.

He had “typical” bird flu symptoms though initial inquiries suggested he had had no contact with poultry, Yen said."

http://www.thanhniennews.com/healthy/?catid=8&newsid=30607

India says outbreak contained after 300,000 birds culled

The outbreak is said to be contained, but there are concerns over several ill children.

"However, state authorities were monitoring the health of four children with fever who had handled dead or sick fowl, and have sent their blood and throat swab samples for testing.
The flare-up of the H5N1 virus in chickens in a small poultry farm near Manipur's capital, Imphal, was the country's first in a year, prompting authorities to kill all poultry and destroy eggs within a 5-km (3-mile) radius. "

http://www.alertnet.org/thenews/newsdesk/DEL261694.htm

Update! Thankfully, The children tested negative.

http://timesofindia.indiatimes.com/India/4_Indian_children_test_negative_for_bird_flu/articleshow/2253961.cms